Wednesday, November 30, 2011
SAN DIEGO Hospital-related infections like sepsis often have deadly consequences. That’s why San Diego hospitals are involved in a statewide initiative to prevent these infections.
At Sharp Grossmont Hospital in La Mesa, the fight to reduce hospital-related infections starts here: in the region’s busiest emergency room.
Three out of four people admitted to Grossmont come in through the ER.
They’re usually the sickest patients, and the ones who are most vulnerable to infection.
That’s why the ER is ground zero in Grossmont’s fight to battle sepsis.
Sepsis is a life-threatening condition that occurs when bacteria overwhelm the body’s immune system.
ER Dr. Julie Phillips said septic patients are in danger.
"They need aggressive therapy. They need it quickly," Dr. Phillips said. "They need it initiated immediately when they come into the ER, and those are the patients we’re trying to pick up as quickly as possible, when they arrive here."
The identification of sepsis begins when a triage nurse assesses the patient.
Dr. Phillips said inside the ER, physicians look for some key indicators.
"Sometimes that is looking for the kidney failure that’s brand new, that’s associated with infection, or the liver failure that’s brand new," Phillips pointed out.
"Often times, the sickest patients are those with extremely low blood pressures, and that’s septic shock. Those are the sickest of the patients."
Not long ago, ER doctors had to send blood samples up to the lab and wait for the results. Thanks to a new hand-held device, that’s no longer necessary.
"For this particular machine," Phillips said, holding the small unit, "the turnaround time is a minute. Because it’s here at the bedside. And so what happens is, if I get a septic patient, who comes in. I suspect sepsis, but I’m not really sure. I can get this machine, and the data done within one minute of the patient’s blood draw. And I have all my data immediately."
Phillips said once sepsis is confirmed, patients immediately get an IV that delivers antibiotics and fluids.
"When we get a protocol, and a set plan, in how we’re going to treat these patients, and everyone abides by it, we save lives," she said.
Sharp Grossmont is just one of many San Diego hospitals that’s taking part in the campaign to reduce infections; 160 hospitals are involved statewide.
About one in 20 Americans get an infection while they’re in the hospital. In fact, hospital-acquired infections are among the ten leading causes of death.
Advanced clinical care nurse Emily Garcia works in Grossmont's surgical intensive care unit.
"Handwashing is priority number one," she said. "It all starts with that. We do it when we enter a room, we do it when we leave a room. And that’s the biggest thing we do to prevent infections."
Garcia's patients are frequently hooked up to IVs and ventilators. These are ideal ports of entry for harmful bacteria.
That’s why Garcia follows a strict protocol when she interacts with patients.
For example, when she changes a patient’s dressing, Garcia performs a series of steps to minimize the risk of infection.
"In here I have what we call a chlorhexidine swab, which I end up scrubbing around the whole site for 30 seconds," she said, as she rubbed the swab near a patient's catheter.
Next, Garcia put a chemically-treated patch around the patient’s catheter, to prevent microbes from entering the line.
Finally, she placed a fresh dressing on the site.
Garcia said these routines are critical to good patient care.
"What if they were our loved ones? What if it was your mom, your dad, your brother, your sister? We wouldn’t want to cause any harm to them. So, we consider each person that comes in here like a family member," Garcia said.
Dr. Barzan Mohedin is an intensive care specialist at Grossmont. He’s convinced if all hospitals did what Grossmont is doing, hospital-associated infections would be a thing of the past.
"If we all implement evidence-based medicine, which is going to prevent hospital-acquired infection, I am sure, that we will be able to achieve the goal that we want, which is zero infection," Dr. Barzan said.
Hospitals aren’t there yet. But the statewide effort has yielded some results. Over the last year-and-a-half, ventilator-associated pneumonia, urinary tract infections, and cases of blood poisoning have all been reduced.